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SIGNATURE PAGE

2021-22

Mail original to: Office of Scholarships & Student Aid, P. O. Box 19496 Shepard Station, Durham, NC 27707

Faxes and emails will not be accepted.

Do not mail this form to the U.S. Department of Education.

North Carolina Central University’s Financial Aid Office recently received the results of your 2021-22 Free Application for Federal Student Aid (FAFSA). According to the information received, the processor did not receive the necessary signatures in order to consider your application acceptable. If you had to supply parent information to complete the FAFSA you must also submit one parent signature. After completing the signature page, return it to the address noted above and we will process the correction for you.

If you are the student, by signing this application you certify that you:

1. Will use the federal and/or state student financial aid only to pay the cost of attending an institution of

higher education,

2. Are not in default on a federal student loan or have made satisfactory arrangements to repay it,

3. Do not owe money back on a federal student grant or have made satisfactory arrangements to repay it,

4. Will notify NCCU if you default on a federal student loan.

5. Will not receive a Federal Pell Grant from more than one college for the same period of time.

If you are the parent or the student, by signing this application you certify that all of the information you provided is true and complete to the best of your knowledge and you agree, if asked, to provide information that will verify the accuracy of your completed FAFSA form. This information may include your Federal Tax Returns that you filed or are required to file. Also you certify that you understand that the Secretary of Education has the authority to verify information reported on this application with the Internal Revenue Service and other Federal agencies. If you purposely give false or misleading information, you may be fined $20,000, sent to prison, or both.

Student’s Contact #:_____________________________________________________________________________________________________________________________

Student’s Name (please PRINT legibly): __________________________________________, _____________________________________, ________________

Last Name First Name Middle Initial

Student’s Signature:__________________________________________________________________________ Date:__________________________________

Parent’s Contact #:_______________________________________________________________________________________________________________________________

Parent’s Name (please PRINT legibly): ____________________________________________, ______________________________________, ___________________

Last Name First Name Middle Initial

Parent’s Signature:___________________________________________________________________________ Date:__________________________________

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ENTER YOUR 9-DIGIT NCCU ID

ENTER YOUR 9-DIGIT NCCU ID

ENTER YOUR 9-DIGIT NCCU ID

ENTER YOUR 9-DIGIT NCCU ID

ENTER YOUR 9-DIGIT NCCU ID

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